Healthcare Provider Details

I. General information

NPI: 1316977424
Provider Name (Legal Business Name): TONYA FRIBERG WARREN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BOULDER POINT DR STE 1
PLYMOUTH NH
03264-3170
US

IV. Provider business mailing address

101 BOULDER POINT DR STE 1
PLYMOUTH NH
03264-3170
US

V. Phone/Fax

Practice location:
  • Phone: 603-536-4000
  • Fax: 603-536-4000
Mailing address:
  • Phone: 603-536-4000
  • Fax: 603-536-4000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2940
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1183
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: